American Maltese Association Rescue

PERSONAL AND HOUSEHOLD INFORMATION

Applicant Name (REQUIRED)	First Name: Last Name:
Co-Applicant Name	First Name: Last Name:
Address (REQUIRED)
City (REQUIRED)
State (REQUIRED)
Zipcode (REQUIRED)
Email Address (REQUIRED)
Home Phone Number: (REQUIRED)
Work Phone Number:
Cell Phone Number: (REQUIRED)
Best time to call:
Occupation/Work Place
Your Age and Co-Applicant Age
Name(s) of other Household Members
Age(s) of other Household Members
Do you have children or grandchildren, other than those living at your home, that would be visiting frequently?
Briefly tell us why you want to adopt a Maltese:

HOUSING

What type of home do you live in?	If Other, please explain:
Do you rent or own your home?
Do you have a fenced yard?
What type of fence?	If other, please explain:
What is the height of the fence (at it's lowest point)
If no fence or on rainy days, how will the dog get exercise or relieve itself?
Does your home have a swimming pool?
If Yes, it is fenced?
Do you have any restrictions regarding pets in your association or neighborhood?

PREFERENCES

Briefly describe the dog you would like: (age, gender, personality, etc.)
Is there a particular dog we have available for adoption that you are interested in?	If yes, which dog?
Are you willing to adopt a dog that may have experienced some form of abuse or neglect that might require extra patience and training to get over some shyness and/or fears?
Are you willing to adopt a dog that has special medical needs and might require a special diet, medications (a pill, eye or ear drops) etc.?
Are you willing to consider a Maltese mix?
Have you owned any Maltese before?

CARE AND RESPONSIBILITY

How will the grooming needs of a Maltese be met??
Can you commit to providing all necessary medical care for this dog for its lifetime?
if you were unable to care for the dog any longer, are you willing to return to AMAR?
How many hours, on an average, will this dog spend alone??
Where would this dog be kept during the hours it is left alone?
Where would this dog sleep at night?
How long will your Maltese be left outside?
Who will have primary responsibility for caring for this dog?
Does anyone in your home have allergies?	If yes, please explain:
Are you willing to re-housetrain your Maltese during the transition period in your home?
We cannot guarantee a dog is 100% housetrained. Most have begun housetraining in their foster homes; however, ALL dogs will have to be re-trained to some extent at their adoptive homes, due to a new sleeping and feeding routine. This not just for rescue dogs, ANY dog going to a new home will have to be re-trained at least to some extent!
Describe your previous experience training a dog?
Who will take care of your dog when you are out of town or on vacation?

PET OWNERSHIP HISTORY

Do you currently own other dogs?

If Yes, please provide information below

Current Dog 1:
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?

Current Dog 2:
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?

Current Dog 3:
Name:
Breed:
Gender
Spayed/Neutered
Age:
Weight:
How Long Owned?
What year did you get this dog?
Where is this dog kept?

Do you have any other pets??	If Yes, please describe:

Have you owned any dogs in the past?
If Yes, please provide information below:

Past Dog 1:
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?

Past Dog 2:
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?

Past Dog 3:
Name:
Breed:
Gender
Spayed/Neutered
Age (when you last had this dog):
How Long Owned?
What happened to this Dog?

REFERENCES

Please provide references, MUST include your Veterinarian AND Groomer if you have one, and a Personal reference. If you rent, your landlord must be listed as a 4th reference. If you do not have a groomer or vet, please include additional personal references. Please contact your references to let them know you have listed them as a reference.


Veterinarian/Clinicc
Name
Address
Phone
Best time to call

Groomer
Name
Address
Phone
Best time to call

Personal Reference
Name
Address
Phone
How does this reference know you?
Best time to call

Landlord
Name
Address
Phone
Best time to call

CERTIFICATION

By initialing here: and submitting this application, I agree to the following statement:

All of the information I have given above is true and complete. Should an unneutered or unspayed dog be placed with me, I agree to have it neutered or spayed within one month of adoption or by a date agreed upon by me and a representative of Maltese Rescue. THIS DOG WILL RESIDE IN MY HOME AS A PET. I will provide it with adequate food, water, shelter, training, affection, and medical care. I understand that Maltese Rescue is a placement service and is not responsible for the accuracy of information received about the temperament, habits or physical condition of dogs available for adoption. I understand that it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adopting. Maltese Rescue is in no way liable or responsible for any damages, accident or injury resulting from this placement of a dog into my household.

Would you like to join our Mailing List?

Please answer this question:

What breed of dog do you see in the picture below?

Upon submission, you will be directed to print out and sign our Application Certification and provide the signed Certification to an AMAR volunteer.

WE RESERVE THE RIGHT TO REFUSE AN APPLICANT
Thank you for contacting Maltese Rescue. We will do our best to match the available dogs to the needs of the adopters; however, our primary interest is the well being of the Maltese.